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A 9-1-1 call is made about an adult female in a single-car accident. The on-call ambulance—only a few miles away from this construction-zone area of freeway—arrives two minutes after dispatch. She is assessed and transported for follow-up care.

This is an account of how an EMS unit should respond. During the 1980s, though, many EMS services struggled to operate efficiently and effectively. When EMS system administrators felt they couldn’t provide each patient with the best possible chance of survival without long-term complications, some asked Jack Stout about High-performance EMS (HPEMS) to save time, save money and, ultimately, save lives.

In the late 1970s, Jack Stout spent time at Oklahoma’s Center for Economic and Management Research, using his team’s work to design High-performance EMS.

After Jack left the industry in the late 1990’s, Jack’s vision has continued to be promulgated by Washko & Associates as an expert guide on the topic, teaching agencies around the globe on how to extract production model economic principles from manufacturing and apply them to a service based industry.

“As EMS providers, we invite the public to literally trust us with their lives. We advise the public that, during a medical emergency, they should rely upon our organization, and not any other. We even suggest that it is safer to count on us, than the resources of one’s own family and friends. We had better be right…

Jack had played an integral role in implementing Kansas City’s new EMS system, called MAST. Jack was at this horrific incident. He wrote a first-person narrative of heroic rescues. Until recently (after conversion from a HPEMS system into a low-performance expensive FD based EMS System), Kansas City’s MAST EMS system was a key example of how to do HPEMS system, correctly following the HPEMS Success Triad, which is an orchestrated balancing of Patient Care, Employee Well-being and long-term financial sustainability

Regardless of actual performance, EMS organizations do not differ significantly in their claimed goals and values. Public and private, nearly all claim dedication to patient care. Efficient or not, most claim an intent to give the community its money’s worth. And whether the money comes from…fees or…tax[es], the claim is the same—the best patient care for the dollars available. It’s almost never true.

For EMS system administrators who struggle to meet performance requirements and patient demands, HPEMS is a trusted method of improving pre-hospital services in ways that use historical data to predict demand and meet the needs of the community.

Our moral obligation to pursue clinical and response time improvement is widely accepted. But our related obligation to pursue economic efficiency is poorly understood. Many believe these are separate issues. They are not. Economic efficiency is nothing more than the ability to convert dollars into service. If we could do better with the dollars we have available, but we don’t, the responsibility must be ours. In EMS, that responsibility is enormous—it is impossible to waste dollars without also wasting lives.”
—Jack Stout (American Ambulance Association – EMS Structured for Quality)